Archive for the ‘crisis’ Category

The draft report from the Overview & Scrutiny committee includes 11 recommendations. We wait to see the final report and progress against each recommendation. We have invited the overview & scrutiny team to attend both our carers meeting and the mental health forum.

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Julie has been scoping services within the Borough and has noticed that the main issue coming up is crisis response. She noted that there were many complaints and comments from GPs. She has been looking at the systems in place and the team’s understanding of their role.

There have been some changes – additional support from medical staff (psychiatrists), a new team leader (Bev Curtis). They have looked at training and are piloting a new scheme at A&E where crisis practitioners attend A&E to assist with out of hours assessments.

They are already seeing some improvements with a reduction in complaints since July 2010.

Carers highlighted:

  • people are not being discharged from hospitals because of accommodation difficulties.
  • communication always needs improving – for example ensuring that carers get time to speak one to one with staff
  • carers not being believed about changes to physical health and weight
  • carers not being prepared, prior to visits, for sudden or more extreme mood changes
  • difficulties on general wards including:
    • carers not being listened to
    •  staff not understanding mental health difficulties and mental capacity
    • access to psychiatric support

Julie emphasised that there is a monthly meeting at the hospital to include herself and managers of the crisis team and A&E, and the consultants. This aims to improve communication. There is a rota of psychiatrists so that there is 24/7 access to their support at the general hospital.

We talked about staff training – including proposals from the Valuing Carers group at 5 Boroughs (Karen attends these meetings).


  • Julie to look at training budgets for staff to ensure that sufficient sessions are available for St Helens staff.
  • Karen to give Julie a copy of the DVD we made.
  • Julie/Gemma to book in regular time to meet with Karen / carers reps.
  • Julie to look at team away days to include carer awareness
  • Julie to ask about access to carers grant now that John Edwards is returned to the local authority (UPDATE – Julie has confirmed that there is no change in the process for accessing this money.)
  • Karen to email a copy of the carers information leaflet to Julie, Jeff and Kim.

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At our meeting in October 2010, carers had a long discussion which could be summarised as four issues:

  1. Crisis response:     Carers described how the crisis response had been an ongoing issue. This is something that services are currently looking at.
  2. Respite:     There is no respite for carers locally. Now service users are being treated more in the community, there needs to be more support for carers. We will look at provision in other Boroughs, especially in Halton.
  3. Medication:     Carers want more involvement and support around medication. They are concerned about side effects, and want to know about alternatives to medication. Carers worry about changes to medication. A few years ago, medications would be changed during an inpatient stay. Now this is happening at home and it worries families.
  4. Discharge and readmission to services:      Some carers were concerned about how to seek help again once the person they support is discharged from secondary care.

We continue to take these to be the four key issues for mental health carers in the Borough.

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Crisis resolution

Simon Barber has confirmed that the Crisis Resolution and Home Treatment teams operate the same on weekends and Bank Holidays as they do at all other times.

He says there is no ultimate definition of what constitutes a crisis both locally and nationally, but the following must be adhered to:

Whenever a person is referred to the Crisis Resolution and Home Treatment team (CRHT) or contacts the service saying they are in crisis the service should assess each case individually.

Every case must be screened, assessed and then once the need of the individual is identified the appropriate action must be taken by the CRHT. The team should then communicate the outcome of their assessment to the individual and/or the referring agent, and GP. Where appropriate it may also be necessary to contact other professionals directy involved in their mental health or social care. This may include a Care Coordinator.

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